Updated January 6, 2016
One of the biggest reasons for neglecting diabetes care is the financial burden. I would love to see this change, so I’ve included a lot of information on reducing costs here. I know how much of a struggle it can be to find help when you cannot afford the things you need.
Recently the pharmacy informed me that Medicare no longer pays for my meter’s test strips. I love my meter because the test strips are embedded in a disc. It makes loading the device much easier, since my fingertips are a bit numb from diabetic neuropathy.
So instead of giving in and switching to the meter they gave me, I went to Amazon online and ordered the discs. The price was the same as my co-pay, so I was able to keep getting what I wanted. Another bonus: I can ignore the limits placed on the number of strips I am “allowed” to use per month.
This is just one small example of the tug-of-war between people with diabetes and the people who are supposed to be helping us get the things we need.
The costs for the daily care of diabetes are high. According to the American Diabetes Association, we have health-care costs more than twice as high as people without diabetes.
The surprise is that almost half of the cost is for inpatient hospital care. Doctor visits account for less than 10%, and medications less than 20%.
These numbers are interesting to me for one reason: When we get regular care, taking medications and seeing doctors at recommended times, there is proof that we do not need hospital care nearly as often. The problem is that too many of us are not getting regular care.
Four things are considered basic to good diabetes management when assessing quality of care. They are a yearly dilated eye exam, a yearly foot exam, at least two HbA1c tests per year, and an annual flu shot. According to the National Healthcare Quality Report for 2008, only about one adult in five with diabetes had all four of these done.
Looking for help
Hitting 65 meant entering the labyrinth of Medicare. It was an eye-opening experience. The information I needed was buried among the pages of a thick book that came in the mail.
I learned that you can be on Medicare and Medicaid at the same time, which can hugely lower your medical costs if you are on a fixed income. But state by state there are wide differences in Medicaid programs.
Going to Medicare and Medicaid directly feels like throwing rocks at an iceberg. But thankfully there are advocacy groups for diabetes. My advice: Take the time to find one in your state.
They will help you navigate through the muddy waters of those organizations to get what you need. Without the help of my advocate I would have lost a lot more than my temper. She made sure I received all the assistance available in my state.
If you do not know where to begin looking for help, the Internet is a place to start. The Generic Assistance Program (GAP) is a resource provided by NeedyMeds and Rx Outreach (a non-profit pharmacy) that provides free generic medications to those who qualify.
The National Council on Aging has a website called BenefitsCheckUp.org that is full of information on benefits programs for older people with limited income and resources. You can find lists of programs broken down into categories like medications, health care, utilities, and even food. You can search by state and by zip code.
RxAssist.org has a database of drug assistance programs provided by pharmaceutical companies. The companies that make prescription drugs will help with things like insulin, glucagon kits, and other diabetes medicines. The website even gives phone numbers for these companies. Some of the information is several years old, so it may be out of date, but it is a place to start.
The Partnership for Prescription Assistance has a website helps people find prescription assistance programs and free or low-cost clinics.
Even the CDC (Centers for Disease Control and Prevention) is involved. They have state-based Diabetes Prevention and Control Programs (DPCPs), providing grants so the states can offer better health-care services to people with diabetes.
Many of these assistance programs use eligibility criteria based on the national poverty level guidelines, stating that your income must be, for example, below 150% or 200% of that level. Those guidelines may change every year.
Poverty linked to diabetes
According to the American Diabetes Association, people with diabetes who did not have insurance have 79% fewer doctor visits and 68% less medication prescribed. But they have 55% more emergency department visits than people with insurance. My daughter, who is an emergency department nurse, tells me that this is true in her experience.
Many experts believe poverty is the number one risk factor for Type 2 diabetes, and they back this up with statistics. One reason may be diet. If you cannot buy healthful food, you use what you can. Whatever is cheapest becomes most of what you eat, and high-carbohydrate packaged food tops that list.
When I was a child, our family ate lots of white bread, cheap cereal, and Kool-Aid. Fruit, lean meat, and whole grains were rare. I know from experience what a poverty-level diet is like.
When you are poor, doctor visits are rare, which means things like prediabetes will never be diagnosed. The cycle of poverty and Type 2 diabetes will only be broken when enough help is made available, especially in poor states like Mississippi where many people with diabetes are not getting the care they need.
You can stop being a statistic if you are willing to ask for help. Get the assistance you need, please.
Terms you need to know
Co-pay. The amount of money you must pay in addition to what your insurance pays for things like doctor visits and medications.
Deductible. The amount you pay before your insurance will cover medical expenses.
Durable Medical Equipment (DME). Medical items (aside from drugs) that are used multiple times. For people with diabetes, these typically include items such as blood glucose meters, insulin pumps, and test strips.
Medicare. The federal health insurance program that helps cover hospital care for people over 65 and certain others with special circumstances.
Medicaid. A federal program administered on a state-by-state basis for financially needy people. It can be combined with Medicare in certain cases.
CHIP. Children’s Health Insurance Program, which provides help for children who cannot qualify for Medicaid. In 2008, 7.4 million children received health coverage through this program.
Federal Poverty Level (FPL). A number set by the federal government every year. It is used to decide eligibility for financial aid. The cutoff is often at least double this level.
Diabetes Education. Training carried out by a diabetes specialist, often a nurse or certified diabetes educator, to aid in management for people newly diagnosed with diabetes or prediabetes. A set amount of this service is covered through Medicare, Medicaid, and sometimes other insurance.
This is a lot of information, I know. But please do what it takes to get the help you need.
Source URL: https://dsm.diabetesselfmanagement.com/blog/make-your-diabetes-care-less-expensive/
Martha Zimmer: Martha Zimmer is a 64-year-old grandmother who has had Type 2 diabetes for the past 14 years. She grew from complete ignorance of diabetes to owning a flourishing diabetes website with thousands of new readers every month. Her passion is to help others with Type 2 diabetes by sharing her mistakes and the things she has learned from them. Meet her at www.a-diabetic-life.com. (Martha Zimmer is not a medical professional.)
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